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Perioperative Serum Albumin and White Blood Cell Count for Early Postoperative Risk Stratification of Superficial Surgical Site Infection After Colorectal Cancer Surgery.

Background: Surgical site infection (SSI) is a common complication after colorectal cancer (CRC) surgery. We evaluated routinely available perioperative biomarkers for early prediction of superficial SSI after curative CRC surgery. Methods: This retrospective study included 488 patients undergoing elective curative CRC resection. Preoperative and postoperative day (POD) 1 laboratory parameters were evaluated using receiver operating characteristic curve analysis and multivariable logistic regression. Results: Superficial SSI developed in 66 patients (13.5%). In the perioperative multivariable

Preoperative inflammatory and immune-nutritional markers and postoperative pulmonary complications after gastric and colorectal cancer surgery: a systematic review and narrative synthesis.

BACKGROUND: Postoperative pulmonary complications (PPCs) remain a major source of morbidity after gastrointestinal cancer surgery. A range of preoperative inflammatory and immune-nutritional biomarkers have been proposed as predictors of postoperative pulmonary risk, but the available evidence remains scattered and methodologically heterogeneous. This study aimed to systematically evaluate the association between preoperative inflammatory and immune-nutritional markers and postoperative pulmonary complications after gastrointestinal cancer surgery. METHODS: Following PRISMA 2020 guidelines, w

Clinical and Metabolic Effects of Preoperative Carbohydrate Loading Before Colorectal Surgery: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND & AIMS: To evaluate the effects of abbreviated preoperative fasting using carbohydrate-containing beverages compared with traditional fasting or placebo in patients undergoing colorectal surgery, expanding upon prior meta-analyses with an updated and more comprehensive evidence base. METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) comparing patients receiving preoperative carbohydrate-containing beverages with those undergoing conventional fasting or placebo. Main endpoints were pla…

Predicting postoperative acute kidney injury after colorectal cancer surgery: development and internal validation of a clinical prediction model using a nationwide cohort.

BACKGROUND: Postoperative acute kidney injury (PO-AKI) occurs in 8-20% of patients undergoing colorectal cancer surgery and is associated with increased mortality and morbidity. A prediction model can help in the identification of high-risk patients and guide clinicians in implementing preventive measures. The present study aimed to develop and validate internally a clinical prediction model for the risk of PO-AKI within 7 days after an elective resection of colorectal cancer, using predictors known before surgery. METHODS: Using a nationwide clinical quality database, all patients with stage

Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients.

Increasing numbers of older people undergo major surgery in the United Kingdom (UK), with many at high risk of complications due to age, co-morbidities or frailty. This article reports on a study of such patients and their clinicians engaged in shared decision-making. Shared decision-making is a collaborative approach that seeks to value and centre patients' preferences, potentially addressing asymmetries of knowledge and power between clinicians and patients by countering medical authority with greater patient empowerment. We studied shared decision-making practices in the context of major su

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… Three types of surgery were chosen as offering different kinds of decisions: orthopaedic surgery for hip or knee replacement, colorectal surgery for bowel cancer and cardiac surgery. … Colorectal surgery for bowel cancer is usually considered essential for survival (generally regarded as life-saving) and requires relatively rapid decisions about treatment. …

Effect of quadratus lumborum block combined with butorphanol-based PCIA on postoperative analgesia and early recovery in patients undergoing colorectal cancer surgery.

OBJECTIVE: To explore the impact of quadratus lumborum block (QLB) combined with butorphanol-based patient-controlled intravenous analgesia (PCIA) on intraoperative opioid use, postoperative analgesia, and recovery indicators in patients undergoing colorectal tumor surgery. METHODS: A retrospective analysis was conducted on 78 patients who underwent radical resection of colorectal tumors. Based on postoperative analgesia strategies, patients were divided into two groups: the QLB combined with butorphanol PCIA group (QB group, n = 38) and the butorphanol PCIA group (B group, n = 40). Parameter

Safety and patient's satisfaction of preoperative carbohydrate drink until 2 hours before colorectal cancer surgery: a single-center, prospective randomized controlled trial.

PURPOSE: Traditionally, fasting from midnight has been a standard practice in elective surgery for reduce the risk of aspiration. However, Enhanced Recovery After Surgery (ERAS) programs recommend clear fluid intake until 2 hours before anesthesia. This study aimed to evaluate the safety and patient satisfaction of preoperative carbohydrate drink intake until 2 hours before colorectal cancer surgery. METHODS: Sixty patients who underwent colorectal cancer surgery between April 2021 and February 2023 at Keimyung University Dongsan Medical Center were enrolled. This study included 30 patients w

A Pathological Complete Response After Pembrolizumab for DNA Mismatch Repair-Deficient/Microsatellite Instability-High Colorectal Cancer Enabling Curative Surgery: A Case Report.

We present the case of a 49-year-old man with initially unresectable, metastatic mismatch repair-deficient colorectal cancer (CRC) who achieved a complete pathological response following neoadjuvant immunotherapy. Metastatic CRC is rarely curable, and complete tumour eradication with standard chemotherapy is exceedingly uncommon. However, deficient mismatch repair/ microsatellite instability-high (dMMR/MSI-H) tumours are uniquely sensitive to immune checkpoint blockade. This patient presented with sigmoid adenocarcinoma with extensive nodal and liver metastatic disease and underwent treatment

Effects of neuromuscular block reversal with neostigmine/glycopyrrolate versus sugammadex on bowel motility recovery after laparoscopic colorectal surgery: A randomized controlled trial.

STUDY OBJECTIVE: To compare the effects of neostigmine/glycopyrrolate (a traditional agent) and sugammadex on bowel motility recovery and the occurrence of digestive system complications after colorectal surgery. DESIGN: Prospective, randomized controlled trial. SETTING: A single tertiary center. PATIENTS: 111 patients undergoing laparoscopic colorectal surgery. INTERVENTIONS: Patients were randomized into two groups based on the block reversal agent: 1) a mixture of 50 μg.kg-1 of neostigmine and 10 μg.kg-1 of glycopyrrolate (neostigmine group) and 2) 2 mg.kg-1 of sugammadex (sugammadex gr…

Application of ultrasound-guided anterior quadratus lumborum block approach at the lateral supra-arcuate ligament in elderly patients undergoing colorectal cancer surgery.

OBJECTIVE: To investigate the anesthetic and analgesic effects of combining general anesthesia with an anterior quadratus lumborum block at the lateral supra-arcuate ligament (SA-AQLB) in elderly patients undergoing laparoscopic radical resection for colorectal cancer (CRC). METHODS: In this prospective study, 92 elderly patients scheduled for radical CRC resection were randomly divided into three groups: ultrasound-guided SA-AQLB group (SA group, n=31), ultrasound-guided subcostal AQLB (SC-AQLB) group (SC group, n=31), and a general anesthesia-only group (GA group, n=30). Measurements includ

Effect of local prolonged-release incisional doxycycline on surgical site infection prophylaxis in abdominal colorectal surgery: the SHIELD 1 randomized clinical trial.

INTRODUCTION: Despite advanced infection control practices including preoperative antibiotic prophylaxis, surgical site infection (SSI) remains a challenge. This study aimed to test whether local administration of a novel prolonged-release doxycycline-polymer-lipid encapsulation matrix (D-PLEX) before wound closure, concomitantly with standard of care (SOC), reduces the incidence of incisional SSI after elective abdominal colorectal surgery. MATERIALS AND METHODS: This was a phase 3 randomized, controlled, double-blind, multinational study (SHIELD 1) between June 2020 to June 2022. Patients w…

Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases (PM) from colorectal carcinoma (CRC). Because of considerable morbidity, optimal patient selection is essential. This study was designed to determine the impact of the onset of PM (synchronous vs. metachronous) on survival outcomes after CRS-HIPEC. METHODS: Patients undergoing CRS-HIPEC for colorectal PM in two academic centers in the Netherlands between 2010 and 2020 were eligible for inclusion. Patients were classified as synchronous (s-PM, i.e., dia

Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases: A Phase 2 Randomized Clinical Trial.

IMPORTANCE: To date, no randomized clinical trials have investigated perioperative systemic therapy relative to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) alone for resectable colorectal peritoneal metastases (CPM). OBJECTIVE: To assess the feasibility and safety of perioperative systemic therapy in patients with resectable CPM and the response of CPM to neoadjuvant treatment. DESIGN, SETTING, AND PARTICIPANTS: An open-label, parallel-group phase 2 randomized clinical trial in all 9 Dutch tertiary centers for the surgical treatment of CPM enrolled partici

Postoperative bleeding and venous thromboembolism in colorectal cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis.

PURPOSE: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for selected patients with peritoneal metastases from colorectal cancer. Previous studies report conflicting rates of postoperative bleeding and venous thromboembolism (VTE) after CRS + HIPEC. The aim of the present study was to systematically review the literature and to estimate the overall 30-day incidence of postoperative bleeding and the overall 90-day incidence of VTE after CRS + HIPEC. METHODS: Studies were identified in PubMed, Embase, and Web of Science on 29 April 2021.

Anatomical study of the inferior mesenteric vein using three-dimensional computed tomography angiography in laparoscopy-assisted surgery for left-sided colorectal cancer.

PURPOSE: To investigate the drainage patterns of the inferior mesenteric vein (IMV) and measure the distance from the root of the inferior m … fe intraoperative navigation and prevention of complications during laparoscopy-assisted left-sided colorectal surgery.

Transcutaneous electrical acupoint stimulation applied in lower limbs decreases the incidence of paralytic ileus after colorectal surgery: A multicenter randomized controlled trial.

BACKGROUND: Postoperative paralytic ileus prolongs hospitalization duration, increases medical expenses, and is even associated with postoperative mortality; however, effective prevention of postoperative paralytic ileus is not yet available. This trial aimed to assess the preventative effectiveness of transcutaneous electrical acupoint stimulation applied in the lower limbs on postoperative paralytic ileus incidence after colorectal surgery. METHODS: After ethics approval and written informed consent, 610 patients from 10 hospitals who were scheduled for colorectal surgery between May 2018 a…

Assessment of Anti-Factor Xa Levels of Patients Undergoing Colorectal Surgery Given Once-Daily Enoxaparin Prophylaxis: A Clinical Study Examining Enoxaparin Pharmacokinetics.

IMPORTANCE: Between 4% and 12% of patients undergoing colorectal surgery and receiving enoxaparin, 40 mg per day, have a postoperative venous thromboembolism (VTE) event. An improved understanding of why "breakthrough" VTE events occur despite guideline-compliant prophylaxis is an important patient safety question. OBJECTIVE: To determine the proportion of patients undergoing colorectal surgery who received adequate anticoagulation based on peak anti-factor Xa (aFXa) levels while receiving enoxaparin at 40 mg per day. DESIGN, SETTING, AND PARTICIPANTS: This prospective, nonrandomized clinica…

Is liquid-based hyaluronic acid equivalent to sodium hyaluronate-based bioresorbable membrane to reduce small bowel obstruction in patients undergoing colorectal surgery.

OBJECTIVE: We performed a prospective randomized study to assess whether the use of sodium hyaluronate-based bioresorbable membrane (Seprafilm®) and liquid-based hyaluronic acid and carboxymethyl cellulose solution (Guardix) to reduce postoperative small bowel small bowel obstruction in patients undergoing colorectal surgery. This study aimed to compare the incidence of postoperative bowel obstruction. METHODS: One hundred seven patients were assigned to the Seprafilm® group and 155 were assigned to the Guardix® group during the study period. The control group of 166 patients received no anti…